I didn’t vote for Barack Obama. But like a lot of Americans, I was hopeful about his presidency.

Just as it took a Republican to thaw our relationship with China, it will probably take a Democrat to reform our entitlement programs. Again and again, Obama promised to step up to the challenge. Then he left the country at the altar and pursued partisan politics instead.

Bill Clinton was going to be the first Democratic president to tackle entitlement spending. Although the effort has been completely ignored by the establishment media, Clinton was planning historic reforms during his second term. These were to include private accounts under Social Security and vouchers for Medicare.

If that doesn’t knock your socks off, you haven’t been paying attention. When Republicans propose these things, Democrats invariably claim the GOP is trying to destroy the social safety net and leave the elderly to fend for themselves.

You left me(Just when I needed you most)

Clinton was serious. He had his Treasury Department draw up detailed plans. In fact, when Pat Moynihan, the colorful intellectual senator from New York, was appointed by President George W. Bush to co-chair the Social Security reform commission, the first thing he did was ask the Treasury to send him the Clinton-era planning documents so that the commission could continue where Clinton’s policy team left off.

So what derailed Bill Clinton’s ambitious reform agenda? Monica Lewinsky. Left wing Democrats in Congress threatened to throw him under the bus in the impeachment proceedings unless he completely dropped the reform ideas they regarded as heresy. Unfortunately for the country, he obliged.

The next opportunity came with Barack Obama. During the Democratic presidential primary in 2008, he was the only serious candidate who called for entitlement reform. Social Security, Medicare and Medicaid, he said, cannot continue on the path they are on. Of course, the left didn’t like hearing this any more than they liked what Bill Clinton was going to propose. Obama was excoriated by New York Times columnist Paul Krugman and was attacked in other liberal quarters as well.

But Obama stuck to his guns and didn’t retreat. That’s one reason I was hopeful when he won the presidency. Initially, I wasn’t disappointed. One of his early achievements was the appointment of a debt commission, headed by former Clinton Chief of Staff, Erskine Bowles, and former Republican senator from Wyoming, Alan Simpson. Almost all of Congress was opposed to this commission (even the Republicans!), but Obama held his ground. He told Bowles and Simpson to forge ahead and do the right thing.

“When you come out with your report, I’ll back you,” the president said. Bowles and Simpson actually believed him.

Alas, it was not to be. And I’m not sure I know why. Has there ever been a president who built up so much hope before abandoning his own public policy troops while they are still in the thick of battle?

Bowles and Simpson reported their bipartisan findings in the fall of 2010. As David Brooks wrote in The New York Times, there was excitement in the air at the time. A bipartisan group of 65 senators pledged to work to find a solution to the nation’s budget woes. The New York Times created on online budget calculator that allowed readers to find their own solutions. The Peter G. Peterson Foundation got six think tanks to propose their solutions.

Yet there was silence at the White House. When the president gave his State of the Union speech a few months later, you would think he never heard of Bowles or Simpson. When the president’s budget came out a few weeks later, again there was no mention of Bowles or Simpson.

The president didn’t merely lose interest in entitlement reform; he went over to the other side! When House Budget Committee Chairman, Republican Paul Ryan, made proposals similar to Bowles and Simpson, the president invited him to a nationally televised White House speechin which he accused Ryan of abandoning the elderly and even of being un-American. Tragically, the person the president was insulting on national TV was the very person he must negotiate with if entitlement reform is ever going to be a reality.

The president’s defenders will probably try to blame Congress for inaction on our most serious domestic policy problem. Nothing could be further from the truth. During 2011, Capitol Hill produced a “gang of six” and “gang of twelve” —bipartisan efforts to reform entitlements, but with zero guidance from the White House. In addition, there were a slew of bipartisan proposals to reform Medicare, most recently a proposal by Ryan and Democrat Ron Wyden. Congress has signaled in every possible way a willingness to act. The only thing missing has been a president willing to guarantee that serious reform efforts would not be demagogued in the next election.

Defenders of the president will probably also claim that ObamaCare is entitlement reform. On paper they are right. According to the Medicare actuaries, President Obama cut Medicare’s unfunded liability in half the minute he signed the health reform act. Unfortunately, there is no serious cost-cutting reform in ObamaCare — only a plan to cut provider payments to the bone. If they carry it out, say the actuaries, one out of every seven hospitals will be out of business in the next eight years and senior citizens will be lined up behind welfare mothers trying to find a doctor who will see them at community health centers and at the emergency rooms of safety net hospitals.

That’s why no one in Washington takes these cuts seriously — at least when they are talking in private. Plus, we’ve seen this scenario play out before. Doctor payments under Medicare are supposed to be growing no faster than national income, but Congress has stepped in to prevent reductions in doctor fees on nine separate occasions.

Governor Chris Christie of New Jersey was harsh, but accurate when he summed up the state of affairs on Meet the Press last Sunday. Christie told Dave Gregory that when President Obama refused to endorse the Bowles/Simpson report he “showed political cowardice and an absolute fear of confronting the great issues of the day.”

The promise Barack Obama made to the voters was unmistakable. He would put partisan politics aside, bring the two parties together and solve our most important public policy problems.

Hi John,
I have the great privilege of knowing Al Simpson and have the highest regard for the patriotism he and Erskine Bowles have demonstrated for our country. Unfortunately, their report is falling on deaf ears. If anything, their alarm is understated, because it looks to ACO’s as being part of a strategy to reduce health care costs. As propounded, the ACO regulations are not demonstrating a great saving potential while causing significant market disruption.

As I have said in recent comments on this blog, health care represents the largest bubble in the history of economics, and when that bubble breaks we will all be in it. One in five dollars in our economy is unstably tied to health care. The increasing financial unreality of our health care system poses a danger to the entire economy and ultimately our national security.

Simpson/Bowles needs to be heeded–and expanded upon by those knowledgeable about health care policy. Unless we harness that one-in-five dollars in our economy and tie our price for health care to its cost, the system and the country will go broke. But more importantly hard working Americans will suffer and die needlessly. Thus if we have concern for our country and compassion for our fellow countrymen, we must wake up and address the fundamentals of health care economics.

“Then he left the country at the altar and pursued partisan politics instead.”

Obama has certainly been a disappointment regarding entitlement reform, but there has been very little attempt to compromise on the right either. Not to mention plenty of demagoguery from both sides. While Ryan’s plan may have been “bold” and “courageous”, if he can’t move to the middle to attempt to get some democratic support, then it’s not really a viable plan at all.

Let’s also be honest about Bowles-Simpson. It had very little mainstream support from either party at the time it was proposed (though perhaps that’s not such a bad thing), and in fact Paul Ryan voted against it. It only started getting support on the right once it was clear that Obama wasn’t going to try to implement the plan, because they realized they could use it to score political points. Otherwise, I’m sure they would have criticized some of its revenue-increasing proposals such as a gas tax and increasing the payroll tax.

I, too, appreciate the history. But your essay ended on a note that seems really off the mark. For most of the essay, you point out how Obama engendered considerable hope that he would tackle entitlements and then how he didn’t. Then, you express a desire for Obama to fulfill his promises. Isn’t that more of the futile hope many people had in 2008? He is locked into a dictatorial presidency in which he has no other trick than to blame Republicans for any short-coming of policy. He isn’t going to change. If we accept that, what are our choices when Congress can’t act either?
We, the citizens of the U.S., are being led by a bunch of spineless no-nothings. Aided, by the way, by the press, that continues to halo the President’s ever action.

You are too smart to pin more hopes on Obama.

Wanda J. Jones, MPH
President
New Century Healthcare Institute.
San Francisco

Unlike you, I never had any hopes that Obama would behave like an American as President. There have been no surprises to the contrary.
He still (at risk of being derisively labeled a “birther”) has not produced a valid birth certificate nor explained his 042 Connecticut Social Security number…which belonged to a dead man.
His destruction of the health care system (and we all on this system agree the present system has faults)…yet to be realized… is almost beyond imagination

John this is an interested narrative, but I think you’re being a little misleading.

First,
The Simpson/Bowles proposal was dead in the water, and any effort by the President to support it would have backfired for two reasons: Republicans simply won’t support anything that a) raises taxes, or b) improves the President’s standing with the electorate. Adoption of Simpson/bowles would have done both, and was therefore a non-starter in Congress.

Second,
As a policy analyst for a large hospital system, I can tell you that several Simpson/Bowles proposals to cut both Medicare (reductions to Graduate Medical Education payments) and Medicaid (reductions to provider taxes, a scheme states use to increase federal matching funds) repeatedly make their way into the President’s favored legislation, including his FY2013 budget, as pay-fors for other programs (the most recent SGR “fix” being an example). To say that he has abandoned efforts to reduce outlays on social benefits programs ignores these basic facts.

I tend to agree that the cost-cutting measures in the PPACA could be better, and that some (ACOs in particular) may make the situation worse. But you can’t ignore the fact that they are in the bill, they are being implemented, and that they are the fruit of long-waged policy debates amongst health economists of all political persuasions. Time will tell if they are successful, and its too soon to judge as little evidence has accumulated.

Lets also not forget that the last major healthcare legislation to be passed by a Republican President, Medicare Part D, was paid-for entirely with the national credit card.

I appreciate your perspective, but the fact is that neither party has a very good track record of fiscal responsibility when it comes to social benefits programs, and the President Obama is actually quite centrist by historical standards.